Table 3.
—Procedure Use and Incidence of Complications Per Procedure
| Evaluation Inconsistent With Guidelines | P Value | |||||
| Invasive Diagnostic Test and Associated Complications | Evaluation Consistent With Guidelines, Mediastinal Sampling Done First | NSCLC Present, Mediastinal Sampling Performed Second or Later | NSCLC Present, Mediastinal Sampling Never Done | Small Cell Lung Cancer Present | Frequency of Test Usea | Incidence of Complicationsb |
| Total patientsc | 3,155 | 4,659 | 5,881 | 1,621 | … | … |
| Procedure | ||||||
| CT image-guided biopsyc | 283 (9) | 2,961 (64) | 3,635 (62) | 743 (46) | < .001 | |
| Complications within 1 d | ||||||
| Pneumothoraxb | 68 (24) | 857 (29) | 843 (23) | 179 (24) | < .001 | |
| Pneumothorax requiring chest tubeb | 11 (3.9) | 182 (6.1) | 245 (6.7) | 52 (7) | .22 | |
| Hemorrhageb | < 11 (< 3.9)d | 30 (1) | 27 (0.7) | < 11 (< 1.5)d | .4 | |
| Respiratory failureb | < 11 (< 3.9)d | < 11 (< 0.4)d | < 11 (< 0.3)d | 0 (0) | .14 | |
| Bronchoscopy without TBNAc | 155 (5) | 3,268 (70) | 4,189 (71) | 1,304 (80) | < .001 | |
| Complications within 1 d | ||||||
| Pneumothorax | < 11 (< 7.1)d | 79 (2.4) | 87 (2.1) | 17 (1.3) | .09 | |
| Pneumothorax requiring chest tube | 0 (0) | 14 (0.4) | 15 (0.4) | < 11 (< 0.8)d | .28 | |
| Hemorrhage | 0 (0) | 39 (1.2) | 39 (0.9) | < 11 (< 0.8)d | .02 | |
| Respiratory failure | 0 (0) | 24 (0.7) | 32 (0.8) | < 11 (0.8)d | .78 | |
| Bronchoscopy with TBNAc | 1,150 (36) | 183 (4) | … | 31 (2) | < .001 | |
| Complications within 1 d | ||||||
| Pneumothorax | 26 (2.3) | 4 (2.2) | … | 0 (0) | 1 | |
| Pneumothorax requiring chest tube | < 11 (< 0.9)d | 0 (0) | … | 0 (0) | 1 | |
| Hemorrhage | 13 (1.1) | < 11 (< 6.0)d | … | < 11 (< 35)d | .32 | |
| Respiratory failure | < 11 (< 0.9)d | 0 (0) | … | 0 (0) | 1 | |
| Mediastinoscopy alone (no thoracotomy)c | 1,218 (39) | 1,390 (30) | … | 132 (8) | < .001 | |
| Complications within 14 d | ||||||
| Pneumothorax | 21 (1.7) | 43 (3.1) | … | 5 (3.8) | .04 | |
| Pneumothorax requiring chest tube | < 11 (< 0.9) | 6 (0.4) | … | 0 (0) | .69 | |
| Hemorrhage | < 11 (< 0.9) | 12 (0.9) | … | < 11 (< 8.3) | .07 | |
| Respiratory failure | < 11 (< 0.9) | 3 (0.2) | … | < 11 (< 8.3) | .33 | |
| Thoracotomyc | 1,630 (52) | 3,903 (84) | … | 93 (6) | < .001 | |
| Complications within 14 d | ||||||
| Hemorrhage | 146 (9) | 408 (10.5) | … | < 11 (< 12) | .14 | |
| Respiratory failure | 157 (9.6) | 454 (11.6) | … | 15 (16) | .03 | |
Data are presented as No. (%) unless otherwise indicated. See Table 1 and 2 legends for expansion of abbreviations.
P value compares the frequency of testing use between groups on a per-patient basis. For bronchoscopy with TBNA, mediastinoscopy alone, and thoracotomy, the comparison is only between guideline-consistent care and guideline-inconsistent care with sampling done second or later.
P value compares incidence of complications on a per-procedure basis among guideline-consistent care, guideline-inconsistent care with sampling done second or later, and guideline-inconsistent care with sampling never done.
Reflects percentage of patients in that group (guideline-consistent care, guideline-inconsistent care with NSCLC sampling done second or later, guideline-inconsistent care with NSCLC sampling never done, and guideline-inconsistent care with small cell lung cancer) who had the test done.
Strata with ≤ 10 patients were suppressed per National Cancer Institute policy and are reported as < 11 to ensure patient confidentiality.